0:00

This case,

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we wanna review a typical appearance of a balloon expanded TAVR

0:06

device.

0:06

So this is a CT examination that was obtained with cardiac gating in

0:11

this patient. They were worried about hypo attenuating leaflet thickening,

0:15

which, uh, something that we talk about in later videos in the course.

0:19

But in fact, actually it was, was normal. The leaflets were normal.

0:22

And so this is,

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I'm just showing this as an example of what you would see with a typical balloon

0:28

expanded, uh, type of TAVR valve. So on the axial images,

0:31

you'll notice that the struts are really dense.

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And this is important to think about because if you're ever doing any post TAVR

0:37

imaging,

0:38

you always wanna make sure to turn off any dose modulation strategies because

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that actually results in so much artifact because of these dense struts that you

0:46

can't actually visualize the structures inside.

0:48

So you always wanna make sure to turn off dose modulation whenever you're

0:52

scanning these post TAVR cases. And then these are the TAVR leaflets themselves.

0:56

You see that they're, um,

0:57

thin leaflets here and they're suspended by the actual TAVR stent

1:02

itself. Now I'm reviewing this on my packs and you know,

1:06

I think just showing that for sort of ease of use within my packs,

1:09

I do have the ability to do some multiplanar reforms,

1:11

which I'm gonna show you here with these multiplanar reforms.

1:16

Just ignore what's going on with this red line and it's not really relevant to

1:20

what we're gonna look at. So for this particular case,

1:22

if you look at on the other views,

1:24

you can see the coronal view actually gives you a nice look at what's going on

1:27

with this TAVR device.

1:29

The balloon expanded device is shorter than the self-expanding,

1:32

which we're gonna show next.

1:34

And you'll see the device actually sits below the levels.

1:38

Here's one of the coronary arteries.

1:40

So here's the coronary art osteum and it's above the level of the TAVR device.

1:45

I can show that a little bit better by doing another oblique reform.

1:49

Show you that. So with that oblique reformat,

1:52

now you can see here really nicely.

1:53

Here's the top of the device and there's the origin.

1:56

So that's one of the reasons it's really important for us to measure coronary

2:00

heights.

2:01

We wanna make sure that the coronary lie above the device and they're not

2:04

blocked by the device itself. Another thing to point out here, as you can see,

2:07

this hunk of calcium here, that's outside the device itself.

2:11

This is actually one of those displaced valve leaflets.

2:14

You know that when we place the device,

2:15

we're actually pushing the native diseased leaflets away,

2:18

and you can see here that's nestled into the sinus for this particular patient,

2:22

which had enough room to accommodate those leaflets.

2:27

One other thing I'm gonna do is I'm just show you a,

2:29

a short axis view looking down the barrel,

2:32

just so you know what these look like. Here's a down the barrel view.

2:36

Here are the prosthetic aortic valve cusps. Notice the sinuses here,

2:40

right coronary, non coronary and left coronary sinuses.

2:43

You can see this wide open right coronary osteo.

2:46

And then you can also see the disease leaflet in the right cusp that I pointed

2:50

out earlier. Finally, the, the right coronary osteo is,

2:54

is actually heavily diseased and quite high in this patient,

2:57

so well above the top of the struts for this particular device. So again,

3:01

this is a balloon expanded device, which is low profile,

3:04

and it's below the coronary artery origins.